"Consultation fees"

[Positivemofo]

If you wonder why a surgeon would have a preference for one brand over another, here is why.

​Based on Open Payments data for the period of 2018–2024, here is how much each surgeon has taken from Coloplast (Colo), Boston Scientific (BS), or Rigicon (Rigi):

​Paul Perito: $3.8M (Colo) | $67k (BS)
​Steven K. Wilson: $1.1M (Colo) | $230k (Rigi)
​Brian S. Christine: $304k (BS) | $25k (Colo)
​Jonathan Clavell: $230k (Colo) | $152k (BS)
​Alex Tatem: $220k (BS) | $16k (Colo)
​Tariq Hakky: $203k (Colo)
​Andrew Kramer: $78k (BS) | $43k (Rigi) | $12k (Colo)

https://openpaymentsdata.cms.gov/

[cbinspok]

you really can leave this site, you ware a thin vale

[GoodWood]

The CMS data you cited shows a correlation, but it does not prove causation. You’ve implied that compensation dictates Dr. A’s choice, ignoring the more logical explanation: he likely uses the product because he finds it superior, and the financial data simply reflects that high volume of use.
To suggest that medical professionals make life-altering decisions for their patients based on greed is a reach. It’s also curious that a 'new' user is already performing this level of technical research on CMS.gov for only their second post. It gives the impression that you are well-acquainted with these boards—perhaps from a previous account—and are simply continuing an old argument under a new name.

[1sfman]

Spot on GoodWood!

[whatevery]

I do want to add something to this.

I live in Boston, home of of Boston Scientific (surprise surprise). At this point I'm still in the process of doctor shopping so I see and virtually speak to many doctors. There are patterns.

It seems like most surgeons in Massachusetts again, home of Boston Scientific, prefer AMS-700. I'm yet to find a urologist that works in one of the local hospitals (besides the VA) that would implant anything other than AMS. Granted they're not high volume famous ones but still.

Kramer who used to prefer Coloplast when he was in Maryland, now since he moved to Mass, prefers AMS-700. He still would implant Coloplast if asked but still.

Most doctors outside of Mass seem to prefer Coloplast.

Is it a coincidence? I don't think so. The goto reasons for preferring one brand over another can be ignored imo. You know, Coloplast is more rigid, while AMS-700 is safer infection wise. I think of them as nothing more than excuses. AMS-700 CX is very rigid while Titan is more than sufficiently infection proof. LGX is a separate matter but its main focus is different from the other two.

I tend to think that main reasons are incentives. Do I have proof? No. I just don't believe in coincidences much.

[jwdetails]

The CMS data you cited shows a correlation, but it does not prove causation. You’ve implied that compensation dictates Dr. A’s choice, ignoring the more logical explanation: he likely uses the product because he finds it superior, and the financial data simply reflects that high volume of use.
To suggest that medical professionals make life-altering decisions for their patients based on greed is a reach. It’s also curious that a 'new' user is already performing this level of technical research on CMS.gov for only their second post. It gives the impression that you are well-acquainted with these boards—perhaps from a previous account—and are simply continuing an old argument under a new name.

This is well put. I don't know how valuable this information is here on FT. If you look at data for different cancer treatments docs often get paid similar for doing ancillary work like running conference, training sessions, advisory roles.

I will point out that this is only the case for private practice urologists - many of the high volume urologists at big "non-profit" hospitals are not allowed to consult to that degree ie. Dr Patel at UCSD, Dr. Mills at UCLA, Tobias Kohler at Mayo clinic, Dr. Carrion at USF, etc.

[ElbowRoom]

You know, Coloplast is more rigid, while AMS-700 is safer infection wise. I think of them as nothing more than excuses. AMS-700 CX is very rigid while Titan is more than sufficiently infection proof. LGX is a separate matter but its main focus is different from the other two.

I tend to think that main reasons are incentives. Do I have proof? No. I just don't believe in coincidences much.

I don’t agree that AMS implants are safer from an infection standpoint. Both have about the same statistical infection rates, they just use slightly different construction to achieve infection resistance. Just a nitpick but I agree with your premise, each implant has advantages and weaknesses.

Doctors have incentive to implant devices than offer them incentives, there is no real way around that. But in the IPP space, I don’t think it’s a big deal because none of the devices are clearly superior to others. If one type was had much higher failure and/or infection rates, but a surgeon who was getting big payouts from the company used them exclusively, that would be a red flag. As it is these incentives are just nudging surgeon preferences among s number of generally equivalent devices.

My advice is to seek out a surgeon that’s willing to implant either brand, even if they have a preference. Or if they are exclusive to one brand they should be able to articulate their preference in a very convincing way.

My surgeon, Dr. Hakky, will implant both brands but has a bias toward Titan mainly because he doesn’t like the Dacron layer of the AMS implants which can grow into tissue and make revision more challenging surgically. He also doesn’t love the rigidity of the LGX implant. I appreciate that he can articulate his reasons but still accepts that there might be circumstances or patient preference that indicate an AMS implant and he’s willing to use them in those cases.